Abstract
A 55-year-old man with schizophrenia developed water intoxication due to primary polydipsia. His manner of antidiuretic hormone secretion was investigated by water loading and infusion of hypertonic saline to clarify the form of the syndrome of inappropriate antidiuretic hormone secretion. The plasma antidiuretic hormone level, which may be involved in the occurrence of water intoxication, was consistently low in this patient, and linked to type D syndrome of inappropriate antidiuretic hormone secretion, designated "hypovasopressinemic antidiuresis". Although this type is not common, it should be considered as a pathophysiology for water intoxication in schizophrenia patients.
Highlights
The syndrome of water intoxication is a clinical entity that occurs in patients with chronic mental disorders
We present here a case of water intoxication in a schizophrenia patient with polydipsia who was studied during a period of stability with provocative physiological challenges
The plasma antidiuretic hormone (ADH) levels linearly increased relative to plasma osmolality (Posm) in the infusion of hypertonic saline
Summary
The syndrome of water intoxication is a clinical entity that occurs in patients with chronic mental disorders. Since excessive water intake alone is rarely sufficient to produce hyponatremia, water intoxication has been linked to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).[1,2] We present here a case of water intoxication in a schizophrenia patient with polydipsia who was studied during a period of stability with provocative physiological challenges. The results of this testing indicate that this is type D SIADH,[3] and that this abnormality was still present during a period of electrolyte stability. About two months later, when his hyponatremia and renal failure had completely improved, we carried out water loading and infusion of hypertonic saline[4] to differentiate his type of SIADH
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